The Netherlands Drug Situation 2010 - Trimbos-instituut

were about 341 deaths among the problem opiate users (range: 333-349). However, for2001 it was found that generalizing the mortality figures from Amsterdam to the whole ofthe Netherlands leads to overestimation, and thus requires correction on overestimation(Cruts et al. 2008). When applying the correction factor that was found in 2001 to theupdated estimate, it is estimated that in 2008 there were about 274 deaths among theproblem opiate users (range: 268-280). It is further estimated that, from these deaths,76 deaths are base rate and are not related to drugs (range: 74-78), whereas 34 deathsare directly related to drugs (range: 33-35), and the remaining 164 deaths are indirectlyrelated to drugs (range: 160-168). Between 2001 and 2008 the total number of drugrelateddeaths in the Netherlands has clearly decreased.In paragraph 6.3 above it was reported that, in 2008 as well as in 2009, 52 deathswere found in the General Mortality Register (Causes of Death Statistics) that were directlyrelated to opiates. The estimation above has resulted in an estimated 34 cases.The registration and the estimation refer to the same target group, and therefore, underideal circumstances, should give the same number. However, registrations and estimationsdo not take place under ideal circumstances. The registered 52 cases and the estimated34 cases fall in the same order of magnitude and therefore do cross validate oneanother.12.2 Conclusions from a public health perspectiveAll in all, three groups of drug users can be distinguished in which drug-related deathsoccur: (1) the traditional group of ageing opiates users, (2) the (new) group of primarycrack cocaine users, and (3) the recreational drug users. The first two groups of problemdrug users were the focus of this chapter.With regard to the group of (ageing) opiates users, it was roughly estimated that in2008 there were 274 deaths among problem opiate users, of which 72% was directly orindirectly related to the use of drugs. Given a population of 11,054,849 people aging between15 and 64 years, this implies only 1.8 'opiates-related' deaths per 100,000 inhabitants.Moreover, the past years show a decreasing trend in these deaths. It should benoticed that, during the past years, a majority of the traditional problem opiates usersalso started abusing other drugs, especially crack cocaine. This implies that the deathsamong opiates users will also to some extent be related to crack-cocaine use, in additionto other (lifestyle) factors. To what extent the drug-related deaths among the problemopiates users are related to opiates or to crack cocaine has not been estimated yet.With regard to the second group of upcoming crack cocaine users, no cohort study isavailable yet to assess the total mortality among these problem drug users. It has beenplanned that, as soon as a substitute treatment will have become available, a cohortstudy can be set up. It is hoped for that in the near future, just like the current methadoneas a substitute for heroin, the slow-releasing "cocadone" (Van den Brink 2010) willbecome available as a substitute for crack. Notwithstanding this current lack of information,the figures from the Dutch General Mortality Register show that from 1996 up toincluding 2009 only in 2002 the number of (acute) cocaine-related deaths approachedthe number of acute opiates-related deaths. Although these statistics do not differentiatebetween crack cocaine and cocaine powder, they suggest that the public health impactfrom crack cocaine will not be larger than the public health impact from opiates. However,these figures do not reflect overall mortality among (crack cocaine users) and it isknown that cocaine use may be underreported as a cause of death.182